Fertility Enrichment Registration

STEP 1a: Please complete this form and submit.

(This form uses email and web based transmission. If you would prefer to submit your information in person, you may contact our office)

Name *

Name

First Name

Last Name

Date of birth *

Date of birth

MM

DD

YYYY

Email Address *

Intention for this appointment? *

Your responses have been sent to a professional at SIMIO. Your next step is to select a Fertility Enrichment Consultation, or Preliminary Examination. We will contact you to schedule following your service requested.

Thank you!

Step 1b: Fertility Health Questionnaire

After sending your contact information above, please click here or below to download a Fertility Health Patient Questionnaire that will need to be completed prior to scheduling your initial meeting.

Fertility Health Questionnaire

STEP 2. Select an initial visit (consultation or preliminary exam)

Consultation is a no-charge meeting to allow questions, discussion, and some basic external exam procedures to determine if you should move forward to Preliminary Examination. All patients proceeding to treatment sessions need to complete the Preliminary Examination. Consultation is provided as a courtesy to aid in discussion and decision making.

Fertility Enrichment Consultation is the face-to-face meeting that starts the process of determining if you are a candidate for fertility treatment at SIMIO. This is a 30-40 minute session that will include:

Review of previous medical history.

Review of previous fertility and/or women's health history.

Objective testing (initial external only measurements)

Discussion of objective testing, inclusion and exclusion criteria for enrollment, and findings.

The Consultation session is optional and can be replaced with the Fertility Enrichment Preliminary Examination. Those traveling a distance, or that are sure that they want to be seen for the entire set of metrics needed for inclusion in the program can skip the consultation and instead enroll in the preliminary examination process. Consultation is offered as a courtesy to those who are exploring fertility options and are interested in more information prior to enrollment. Phone consultations are also an option on an as needed basis.

Fertility Enrichment Preliminary Examination is the second step for most patients. Unless you are traveling a distance, had your initial consultation discussion over the phone or email, or met inclusion criteria during a separate meeting, you will have had an opportunity to discuss your fertility journey and are ready to collect the objective data needed to determine your eligibility to enroll in Fertility Enrichment Treatment visits. Your Preliminary Examination will include:

Review of Consultation notes and questions.

Objective testing (external and initial internal measurements will be taken. This visit includes intra-pelvic examination)

Discussion of objective testing, inclusion and exclusion criteria for enrollment, and findings.

The Fertility Enrichment Preliminary Examination is the most complete step in determination of eligibility to enroll in the program. Your eligibility and scheduling options for treatment will be discussed with you at the end of this visit.

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Step 3: WAIT for your preliminary exam findings.

After your Preliminary Examination, you can proceed to the next step.

Step 4: If enrollment is granted, select your Enrichment session

Fertility Enrichment treatment sessions are the third step for most patients. Once eligibility is determined in our Preliminary Examination, you will have the opportunity to purchase enrichment sessions. The Fertility Enrichment program is available in packages of up to 5 sessions. Some women require up to 5 sessions, some require more based on objective change, prior medical and personal history, fertility history, and other factors unique to each individual. Your Fertility Enrichment Sessions will include:

Review of Preliminary Examination findings and questions.

Objective testing (Subsequent external and internal measurements will be taken. These visits may include intra-pelvic examination)

Treatment of objective findings.

Establishment and instruction of a self treatment and/or home exercise program.

Please select the appropriate session package for your visits. Once advised to enroll (following the Preliminary Examination findings), those enrolling for the first time should select the Initial package (up to 5 sessions). Those needing additional program sessions following the Initial sessions are attended should select Secondary Sessions (up to 5 additional sessions). If you have attended Secondary Sessions and are in need of continuation, you should scroll down and select Extended Sessions (Up to 5 additional sessions).

Some patients have unique histories and more complex bodies. While most patients progress quickly, some may need more care than others. Select Extended Sessions only if you have attended Initial and Secondary program sessions and are in need of additional Fertility Enrichment treatment program sessions.